Healthcare Provider Details

I. General information

NPI: 1134731060
Provider Name (Legal Business Name): ANGELIE NOELLE TOLENTINO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL BLVD
CANONSBURG PA
15317-9762
US

IV. Provider business mailing address

100 MEDICAL BLVD
CANONSBURG PA
15317-9762
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-3030
  • Fax: 412-359-3060
Mailing address:
  • Phone: 412-359-3030
  • Fax: 412-359-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00573600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA067124
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: